Mohamad Alkhouli1, Craig R Narins1,2, Juan Lehoux3, Peter A Knight3, Bryan Waits1, Frederick S Ling1. 1. Division of Cardiovascular Diseases, Department of Medicine, University of Rochester, Rochester, New York. 2. Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, New York. 3. Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester, Rochester, New York.
Abstract
OBJECTIVE: Extracorporeal membrane oxygenation is an important therapeutic option for patients with refractory cardiogenic shock. Adequate decompression of the left ventricular in these patients is a key predictor of successful recovery. The currently available percutaneous decompression techniques are limited by their partial unloading capability. METHOD: We describe a series of four consecutive patients with refractory cardiogenic shock in whom adequate left ventricular decompression was achieved by integrating a transseptally placed left ventricular cannula into the existing extracorporeal membrane oxygenation circuit. RESULTS: From May to June 2015, four consecutive patients underwent transvenous transseptal left ventricular decompression with a 22 French cannula that was integrated into the extracorporeal membrane oxygenation circuit in a Y fashion. The mean age was 47.5 ± 20 years. All patients had refractory shock, and three patients failed prior decompression with an intra-aortic balloon pump. Fluoroscopy time was 12.15 ± 2.6 minutes. No procedural complications were noted. All patients had significant reduction in their pulmonary capillary wedge pressure and resolution of their pulmonary edema. Two patients died during the hospitalization due to sepsis and/or multiorgan failure. CONCLUSION: Antegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema.
OBJECTIVE: Extracorporeal membrane oxygenation is an important therapeutic option for patients with refractory cardiogenic shock. Adequate decompression of the left ventricular in these patients is a key predictor of successful recovery. The currently available percutaneous decompression techniques are limited by their partial unloading capability. METHOD: We describe a series of four consecutive patients with refractory cardiogenic shock in whom adequate left ventricular decompression was achieved by integrating a transseptally placed left ventricular cannula into the existing extracorporeal membrane oxygenation circuit. RESULTS: From May to June 2015, four consecutive patients underwent transvenous transseptal left ventricular decompression with a 22 French cannula that was integrated into the extracorporeal membrane oxygenation circuit in a Y fashion. The mean age was 47.5 ± 20 years. All patients had refractory shock, and three patients failed prior decompression with an intra-aortic balloon pump. Fluoroscopy time was 12.15 ± 2.6 minutes. No procedural complications were noted. All patients had significant reduction in their pulmonary capillary wedge pressure and resolution of their pulmonary edema. Two patients died during the hospitalization due to sepsis and/or multiorgan failure. CONCLUSION: Antegrade transseptal left ventricular decompression is feasible in patients on extracorporeal membrane oxygenation and persistent pulmonary edema.
Authors: Mohamad Alkhouli; Ahmed Al Mustafa; Zakeih Chaker; Fahad Alqahtani; Sami Aljohani; David R Holmes Journal: J Card Surg Date: 2017-03-07 Impact factor: 1.620
Authors: Ali İhsan Hasde; Mehmet Cahit Sarıcaoğlu; Nur Dikmen Yaman; Çağdaş Baran; Evren Özçınar; Mehmet Çakıcı; Mustafa Bahadır İnan; Ahmet Ruchan Akar Journal: Interact Cardiovasc Thorac Surg Date: 2021-04-08